FactCheck Scotland: has the Scottish government protected the NHS?

The claim

“We’ve protected Scotland’s NHS from the Tories’ cuts.”

Alex Neil

The background

The yes campaign says independence is the best way to protect the NHS in Scotland.

But confidential documents passed to the BBC by a senior whistle-blower suggest there is a £400m funding gap on the horizon and the devolved health service will need sweeping reforms to cut costs after the referendum.

The claim has forced the Scottish government to defend its record on running the devolved NHS.

Health Secretary Alex Neil said: “We’ve protected Scotland’s NHS from the Tories’ cuts, and with independence we can ensure that it is never again under threat from Westminster’s dangerous obsession with austerity.”

The analysis

Let’s remember the fundamentals. Westminster gives Scotland a block grant – a lump sum to spend on public services as Holyrood sees fit.

London can and has cut this block grant, leading to overall reductions in the Scottish government’s spending power since 2009/10.

But NHS spending in England has gone up in the same period (slightly) and the Barnett formula means that more spending in England equals more spending in the devolved regions too. It’s up to Scotland how it spends the money that arises from the Barnett system.

The Scottish government says it has protected the NHS budget. Is that true? Well, spending has gone up in cash terms, but not in real terms.

Mr Neil actually switched cleverly between the two in one sentence today when he said: “Despite Scotland’s budget being slashed by 7.2 per cent by George Osborne between 2010/11 and 2015/16, our increases in health spending means that the NHS is receiving record high funding, with a budget increase of over £1bn between 2010/11 and 2015/16.”

The 7.2 per cent cut (to the block grant) is in real terms, but the £1bn increase is in cash, and £1bn over five years is eaten up by inflation.

But it’s true the total amount of money allocated to Scotland in the block has gone down, so perhaps the Scottish government had no choice but to cut health spending slightly, given all the other pressures on its budget?

That’s certainly one way of looking at it, but the IFS makes two further points.

First, Scotland has suffered less from austerity cuts than England: “Over the same period the vagaries of the Barnett formula mean that Scotland will have had to cut overall public service spending by less — by about 8 per cent rather than 13 per cent. But the Scottish government has chosen to protect the NHS in Scotland slightly less than it has been protected in England.”

And the trend of spending less money on Scotland’s NHS than the Barnett formula allows pre-dates the era of austerity:

“This is not a new pattern. Between 2002-03 and 2009-10 – years of plenty for public services rather than cuts – real-terms health spending per person grew by 29 per cent in Scotland compared with a 43 per cent increase across the UK as a whole.

“This was despite overall public service spending per person growing by a very similar amount in Scotland (26 per cent) and the UK as a whole (28 per cent).

“So it seems that historically, at least, Scottish governments in Holyrood have placed less priority on funding the NHS in Scotland (and more on funding other services) than governments in Westminster have for England.”

Other independent research backs this up. This Nuffield Trust-funded study also found that Scottish governments spent less on health than England between 2000/01 and 2012/13, building up a surplus of about £900m to spend on other services.

The verdict

The idea that the Scottish government has bravely struggled to protect the NHS budget under intolerable pressure from Westminster is contradicted by independent research.

The reality is that Scottish governments have for some years chosen to increase health spending by less than it went up in England.

On the other hand, it remains the fact that without independence, Scotland is at the mercy of politicians in London if they want to cut the overall budget for public spending north of the border.

Perhaps the fairest way to sum this up is that there are risks attached to staying in the union and to becoming independent.

The IFS and many others have said that an independent Scotland will face tough spending decisions in the future, thanks to falling oil revenues and an ageing population.

But we know that there are more cuts to Scotland’s block grant on the way under the coalition, and Labour have made a commitment to continuing with a programme of austerity if elected.

More from Channel 4 FactCheck

4 reader comments

Celia Burnsays:

Not only have there been cuts in real terms to the NHS in Scotland there has also been privatisation of some sevices that has had a direct effect on the range and quality of services provided. In many rural areas pharmacies have been removed from doctors surgeries and handed over to private companies. This was pushed through following legislation from the Scottish Parliament despite vigorous campaigns by doctors and patients to keep dispensaries within surgeries. Our GP resigned as she felt unable to maintain the full range of services. Patients are suffering a real reduction in services as a result of an SNP policy of privatisation.

“…the devolved health service will need sweeping reforms to cut costs after the referendum.”

What utter, utter lying claptrap.

The aim of this of course is to get more privatisation into the system to “save” it, either through ripoff loans or salami slicing of medical services. Up to now this has been called “Private Finance Initiative” – bulls*** lingo for profiteering at the expense of patients. It’s the usual cowardly neocon back door approach to the NHS. These cowboys know perfectly well if their intentions were fully exposed by honest media (we can dream) they would be booted all the way back to Texas and Frankfurt.

This is just the first shot of international capitalism in the event the Scots vote Yes. Expect it to get much, much worse if Scotland votes to leave the Union. The last thing the criminal bankers want is a successful Scotland of social fairness and an example to others. We have already seen their attacks on anybody who kicked them out, such as Venezuela and Cuba. There are many others.

If Scotland does leave this Englishman will understand and wish them luck. But I fear for them.

Not sure if you are comparing like with like. As part of the Scottish Government’s “change agenda” monies were also allocated to Health Boards and Scottish Councils on condition that they could come up with a satisfactory arrangement for targeting these funds and working in partnership. Initially the target for such monies was in resolving the situation around care for the elderly, ending “bed-blocking” and similar programmes. Do the figures you have used include or exclude the monies allocated to the “change funds” that I understand are in the region of £50m a year. Would be helpful to get an answer.

Even if demand and the level of service was to remain constant, the cost of the NHS in England would have increased in recent years to meet the extra cost of contracting, monitoring and record keeping consequent on marketisation.

If I seek three tenders from plumbers to replace my bath, the estimating cost borne by unsuccessful tenderers and the cost of the process of seeking tenders and evaluating them has to be met by someone. It gets recovered in the price of the next tender.

There is also a cost inherent in opening up of opportunities for fraud and the consequent degredation of the reliability of data. My one disappointment in Nicola Sturgeon as Health Secretary was that she seemed SURPRISED as well as angry when she found that waiting times data was fiddled.